Siva Sankar A, O K Prakashen, Banu Khamar J, Pon Chidambaram M
Surgical Gastroenterology, Government Mohan Kumaramangalam Medical College Hospital, Salem, IND.
Surgical Gastroenterology, Madras Medical College, Chennai, IND.
Cureus. 2022 Sep 15;14(9):e29181. doi: 10.7759/cureus.29181. eCollection 2022 Sep.
Background Internal pancreatic fistula (IPF) is a complex disease with different etiologies, varied clinical presentations, and multiple management options. Unlike postoperative pancreatic fistula, IPF lacks guidelines for classification and management. The rarity of the disease makes randomized control studies unlikely and difficult to formulate guidelines. This has resulted in different approaches to managing IPF. IPF associated with both acute and chronic pancreatitis is treated with a step-up approach. Chronic pancreatitis-associated IPF treated with the traditional step-up approach is associated with increased morbidity. Prolonged fasting, drainage of protein-rich pancreatic fluid, and extended hospital stay add to the morbidity. Early surgical intervention in patients with IPF associated with chronic pancreatitis can treat both the fistula and underlying disease processes simultaneously. This may contribute to reduced morbidity and hospital stay. Methodology A retrospective observational study was conducted between June 2018 and May 2019. IPF patients with fluid amylase >1,000 IU/L and fluid albumin >3 g/dL were included in the study. Results In total, 32 patients were included in the study. A total of 13 patients had acute pancreatitis and 19 were associated with chronic pancreatitis. Pseudocyst and walled-off pancreatic necrosis were present in 18 patients. The duration of treatment for the traditional group was 8-14 weeks, and for the early surgery group, it was 8-10 days. Patients were followed up for two years, and none of the patients in the early surgery group had a recurrence. Conclusions The overall mortality of IPF is low but it has high morbidity. The delay in treatment may contribute to high morbidity; hence, early surgical intervention may change the clinical course. The primary pathology of the pancreas can be addressed simultaneously as well. In our study, early surgical intervention was associated with lesser morbidity and decreased duration of hospital stay while recurrence rates and mortality were comparable to the traditional management protocol.
背景 胰腺内瘘（IPF）是一种病因各异、临床表现多样且有多种治疗选择的复杂疾病。与术后胰瘘不同，IPF缺乏分类和管理指南。该疾病的罕见性使得随机对照研究不太可能进行，也难以制定指南。这导致了管理IPF的方法各不相同。与急性和慢性胰腺炎相关的IPF采用逐步升级的方法进行治疗。采用传统逐步升级方法治疗的慢性胰腺炎相关性IPF与发病率增加有关。长时间禁食、富含蛋白质的胰液引流以及住院时间延长都会增加发病率。对与慢性胰腺炎相关的IPF患者进行早期手术干预可以同时治疗瘘管和潜在的疾病过程。这可能有助于降低发病率和缩短住院时间。
方法 于2018年6月至2019年5月进行了一项回顾性观察研究。纳入了胰液淀粉酶>1000 IU/L且胰液白蛋白>3 g/dL的IPF患者。
结果 本研究共纳入32例患者。其中13例患有急性胰腺炎，19例与慢性胰腺炎相关。18例患者存在假性囊肿和包裹性胰腺坏死。传统组的治疗时间为8 - 14周，早期手术组为8 - 10天。对患者进行了两年的随访，早期手术组无一例复发。
结论 IPF的总体死亡率较低，但发病率较高。治疗延迟可能导致高发病率；因此，早期手术干预可能会改变临床病程。胰腺的主要病理问题也可以同时得到解决。在我们的研究中，早期手术干预与较低的发病率和缩短的住院时间相关，而复发率和死亡率与传统管理方案相当。
